Potpourri 2016 LipidSpin Articles | National Lipid Association Online

JOYCE L. ROSS, MSN, CRNP, FPCNA, FNLA	From the NLA President: Newly Published Guidance for Non-Statin Therapies from the American College of Cardiology In April 2016, an expert consensus decision pathway on the role of non-statin therapies for lowering LDL-C in the management of atherosclerotic cardiovascular disease (ASCVD) risk was published in the Journal of the American College of Cardiology. This document, which was endorsed by the National Lipid Association (NLA), and with the diligent and consistent work of our Immediate Past President Carl Orringer, MD, as one of its authors, provides practical guidance for clinicians and... more
JOSEPH J. SASEEN, PharmD, BCPS, BCACP, FNLA	From the LipidSpin Editor: HOPE Springs Eternal for Intermediate-Risk Primary Prevention Patients The annual Potpourri edition of the LipidSpin is one of my favorites. What is published typically reflects what is in the forefront of the minds of several clinical lipidologists and clinical lipid specialists. I have spent the past several months debating how the 2016 American College of Cardiology Expert Consensus Decision Pathway, endorsed by the National Lipid Association (NLA), will change my practice.¹ I have also anticipated (fretted might be a better word... more
DANIEL SOFFER, MD, FACP, FNLA	From the LipidSpin Editor: Looking Back, Moving Forward It is a great time to be a clinical lipidologist and I want to thank all of the readers for a wonderful year as co-editor of LipidSpin! It has been the year of the PCSK9 inhibitor introduction and that has captured everyone’s attention. But that is not all that is going on in clinical lipidology; our field is rolling and we have tried to cover as much of it as possible in the LipidSpin this past year. Since our last Potpourri issue, we have covered primary prevention, lipid... more
CEZARY WÓJCIK, MD, PhD, FNLA	The Advent of PCSK9 Inhibitors in Real Life Patients of all ages and with all kinds of problems seek help in our busy family medicine clinic (10 providers, 33,000 visits a year), which is part of a four-clinic network of the Oregon Health & Science University (OHSU) Family Medicine Department. I work independently (although we do collaborate) from the OHSU Preventive Cardiology Division as the only lipidologist within our department, taking referrals from my colleagues. When the U.S. Food and Drug Administration (FDA)... more
ALLISON DUCHARME-SMITH, MD VIRAJ PRAKASH RAYGOR, MD BALINT LACZAY, MD NEIL J. STONE, MD, MACP, FNLA	Search for the Secondary Cause: Worth the Pause The approach to understanding hypercholesterolemia, hypertriglyceridemia, or both, starts with consideration of the underlying lipoprotein abnormalities present.^1,2 This is followed by asking to what degree genetic or acquired causes explain the observed abnormalities. Since those with lipoprotein abnormalities and increased risk for either atherosclerotic cardiovascular disease (ASCVD) or pancreatitis are candidates for drug therapy, finding acquired causes and instituting... more
DONALD G. LAMPRECHT Jr., PharmD, BCPS, FNLA SHEILA L. STADLER, PharmD, BCPS-AQ Cardiology	Clinical Conundrum: The Estimated LDL-C Below 40 mg/dL Recent clinical trial data has strengthened the argument that lowering low-density lipoprotein cholesterol (LDL-C) to levels well below those previously targeted provides incremental benefit in terms of lowering the risk of atherosclerotic cardiovascular disease (ASCVD).¹ The increased use of high-intensity statins, irrespective of baseline LDL-C, has resulted in clinicians more frequently encountering LDL-C levels below 40 mg/dL. The 2013 American College of Cardiology/ American... more
SEAN D. STEWART, PharmD, BCACP, FNLA	CETP Inhibitors Remaining in Clinical Development: A History and Update for Clinicians Statins currently stand as the cornerstone of therapeutic strategies for the reduction of atherosclerotic cardiovascular events.^1–4However, despite their chronicled successes over the past 30 years since the U.S. Food and Drug Administration (FDA) approved lovastatin, multiple analyses of clinical trial data reveal residual cardiovascular risk in patients treated with statins, even those achieving optimal reduction of low-density lipoprotein cholesterol (LDL-C).⁵... more
EDWARD GOLDENBERG, MD, FNLA STEPHEN MENG, MD	Coronary Artery Calcium Scoring in Decision Making: the MESA Score Evaluation of a patient’s risk for cardiovascular disease (CVD) is the basis of deciding whether to institute statin therapy. The 2013 ACC/AHA Guidelines on the Assessment of Cardiovascular Risk recommend using the Pooled Cohort Equation to predict the 10-year risk of having an atherosclerotic cardiovascular disease (ASCVD) event in non-Hispanic Whites and African Americans, 40 to 79 years of age. This calculation includes all forms of cardiovascular disease, including stroke and coronary... more
Omega-3 Fish Oil: Cardioprotective or Not?	Omega-3 Fish Oil: Cardioprotective or Not? Often there is a dichotomy regarding information published in the lay press versus what is presented in the medical literature. So it’s nice when both agree, except on those rare occasions, when both get it wrong. Despite numerous epidemiologic and observational studies to the contrary, Men’s Health had a recent article titled “Is Fish Oil the New Snake Oil?”^1–4 They based that on several recent “high-profile reviews” in “trusted medical journals” that no longer supported... more
JUDITH A. COLLINS, MSN, APRN-BC, FPCNA, FNLA	Statin Therapy for the Very Elderly >80 with ASCVD: Balancing the Benefits and Risks There is a large population >80 in the U.S., some who have either been advised to or chose to discontinue statin therapy. Randomized clinical trials have typically excluded very elderly subjects or group all elderly into age >65. There are vast differences in this population in terms of frailty vs. vigorousness, comorbidities, motivation, and financial resources. In the rapidly growing 80+ age group, the prevalence of ASCVD exceeds that of younger age groups, affecting 84.7 percent of... more
ROLF L. ANDERSEN, MD, FACC, FNLA LARS ANDERSEN, BA	The Potential Role of Universal Genetic Screening for Familial Defective Apolipoprotein B-100 in Southern Pennsylvania Familial defective apolipoprotein B-100 (FDB) is an autosomal dominant disorder of lipid metabolism considered by international guidelines to be a genetically defined cause of familial hypercholesterolemia (FH).^1–3 FDB arises from mutations in apolipoprotein B (apoB) affecting the affinity of apoB-containing low-density lipoprotein particles for the low-density lipoprotein receptor (LDL-R) and, subsequently, their rate of endocytosis and catabolism in hepatocytes.⁴ FDB... more
R. PRESTON MASON, PhD DANIEL E. HILLEMAN, PharmD	Omega-3 Fatty Acid Fish Oil Dietary Supplements for Disease Management: Are They Appropriate for Patients? Perceptions of Fish Oil Dietary Supplements (FODS) According to 2008 national health statistics, fish oil dietary supplements (FODS) are the most commonly used supplements among U.S. adults.¹ There is a general public perception that consumption of fish is a healthy dietary habit.² This perception may be responsible for a greater than threefold increase in the use of FODS among older adults in the U.S. over the past decade.³ Individual... more
JAMES J. MACIEJKO, MS, PhD, FACC PREMCHAND ANNE, MD, MPH, FACC MANISHA RAVI	Pseudohypertriglyceridemia in a Teenager: Evaluation, Management, Implications, and Literature Review Pediatric hypertriglyceridemia (fasting triglycerides ≥ 130 mg/dL) was identified by routine screening in a healthy 14-year-old male. He was subsequently referred to our pediatric lipid clinic for evaluation. A fasting lipid profile confirmed hypertriglyceridemia: total cholesterol (TC): 136 mg/dL, triglyceride (TG): 357 mg/dL, low-density lipoprotein cholesterol (LDL-C): 18 mg/dL, high-density lipoprotein cholesterol (HDL-C): 47 mg/dL, and non-HDL-C: 89 mg/dL. The patient is... more
RAM Y. GORDON, MD DAVID J. BECKER, MD	Red Yeast Rice as an Alternative Therapy for Hyperlipidemia Some patients refuse statin therapy or cannot tolerate its side effects. Many of these patients seek alternative therapies, including red yeast rice (RYR), a widely available herbal supplement made by culturing a yeast, Monascus purpureus, on rice. This process produces 14 monacolins, compounds that inhibit HMG- CoA reductase, the rate-limiting step in hepatic cholesterol synthesis.¹ One of the monacolins produced is monacolin K, which is chemically identical to lovastatin. ... more
ANNE C. GOLDBERG, MD, FNLA	Foundation Update The National Lipid Association and the Foundation are thankful once again for another successful year of meetings and fundraising. But we still have much work to do. If you are onsite at the Fall CLU in Amelia Island, make sure to purchase a ticket to the Foundation Event for an evening of miniature golf on Aug. 27 from 6:30–8:30 p.m. Engage your peers in a friendly competition through 18 holes on the Heron Cove Adventure Golf course located at the Omni Amelia Island Plantation... more